Duodenal Vascular Compression Syndrome
Introduction
Introduction to duodenal vascular compression syndrome Duodenal vascular compression syndrome refers to the intestinal obstruction caused by the compression of the superior mesenteric artery in the third part of the duodenum (ie, the transverse section), so it is also called superior mesenteric artery compression syndrome, Wilke syndrome and ten Duodenal stasis and so on. Duodenal obstruction caused by superior mesenteric artery compression can be divided into acute and chronic types, and chronic obstruction is the most common type in clinical practice. Duodenal vascular compression syndrome should be treated with non-surgical treatment. basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: dehydration malnutrition
Cause
Causes of duodenal vascular compression syndrome
Cause:
The duodenal transverse segment is located behind the retroperitoneum and is the most fixed part of the digestive tract. It traverses from the right to the left across the third lumbar vertebrae and the abdominal aorta. The distal end of the duodenum is again covered by the duodenal suspensory ligament ( The Trietz ligament is fixed, and the posterior part is the vena cava, the vertebral body and the abdominal aorta. The anterior superior mesenteric artery is traversed by the mesenteric vascular bundle in the mesenteric root. The superior mesenteric artery is usually separated at the level of the first lumbar vertebrae. At an angle of 30 to 42 degrees, if the angle between the superior mesenteric artery and the abdominal aorta becomes smaller, the superior mesenteric artery can press the transverse part of the duodenum to the vertebral body or the abdominal aorta, causing intestinal stenosis and obstruction. .
The above-mentioned mechanical obstruction is often the result of a combination of factors, such as a narrow angle at the beginning of the superior mesenteric artery, and the duodenal suspensory ligament is too short to fix the distal end of the duodenum at a higher position. The superior mesenteric artery originates from the position of the abdominal aorta too low, and there is abnormal walking of the superior mesenteric artery in front of the duodenum across the vertebral body. In addition, lumbar lordosis, duodenal suspensory ligament and mesenteric root Adjacent lymphadenitis, decreased mesenteric and posterior peritoneal fat, visceral ptosis, etc. can reduce the gap between the spine and the proximal part of the superior mesenteric artery, which easily causes the duodenum to be oppressed.
Prevention
Duodenal vascular compression syndrome prevention
There is no particularly effective preventive measure for this disease. Early detection and early treatment are the key to the prevention and treatment of this disease.
Complication
Duodenal vascular compression syndrome complications Complications dehydration malnutrition
Long-term repeated vomiting can be complicated by weight loss, dehydration and systemic malnutrition.
Symptom
Duodenal vascular compression syndrome symptoms Common symptoms Fatigue anorexia, weakness, dehydration, weight loss
Duodenal obstruction caused by compression of superior mesenteric artery can be divided into acute and chronic types. Acute obstruction has many gastrointestinal prodromal symptoms, often secondary to torso plaster fixation, traction or lying on overextended stents. After that, the main manifestations are signs of acute gastric dilatation.
Chronic obstruction is the most common type in the clinic. The main symptoms are vomiting, which occurs after meals. The vomit contains bile and food. The symptoms are intermittent recurrent. The remission period is long or short. The symptoms may change due to body position. And reduce, such as side lying, prone, chest and knees, etc., this is the characteristics of this disease, vomiting is often accompanied by abdominal pain, or only the upper abdomen swelled discomfort, during the remission period may have fullness after eating, fatigue, Inability, nervousness, anorexia and emotional instability, long-term repeated vomiting leads to weight loss, dehydration and systemic malnutrition.
Examine
Duodenal vascular compression syndrome
Gastrointestinal barium meal can be seen in the duodenum first, two dilatation, and repeated strong reverse peristalsis, the tincture can be refluxed into the stomach, there is a neat oblique line in the far side of the duodenal transverse segment and When the expectorant is blocked, the swallowed meal cannot be evacuated from the duodenum after 2 to 4 hours, indicating that there is an obstruction. If the patient takes the prone or the left lateral position, the duodenal retention disappears. This is very helpful for the diagnosis of this syndrome.
At the same time, aortic angiography and expectorant examination can show the relationship between duodenal compression and superior mesenteric artery, narrowing angle between superior mesenteric artery and abdominal aorta, and abnormal operation of superior mesenteric artery, but clinically very Less need for aortic angiography.
Diagnosis
Diagnosis and diagnosis of duodenal vascular compression syndrome
diagnosis
Can be diagnosed based on clinical symptoms and laboratory tests.
In patients with repeated vomiting of bile and food, especially when the body position changes can alleviate the signs, the possibility of superior mesenteric artery syndrome should be considered, and further gastrointestinal barium examination is needed.
Gastrointestinal barium meal can be seen in the duodenum first, two dilatation, and repeated strong reverse peristalsis, the tincture can be refluxed into the stomach, there is a neat oblique line in the far side of the duodenal transverse segment and When the expectorant is blocked, the swallowed meal cannot be evacuated from the duodenum after 2 to 4 hours, indicating that there is an obstruction. If the patient takes the prone or the left lateral position, the duodenal retention disappears. This is very helpful for the diagnosis of this syndrome.
At the same time, aortic angiography and expectorant examination can show the relationship between duodenal compression and superior mesenteric artery, narrowing angle between superior mesenteric artery and abdominal aorta, and abnormal operation of superior mesenteric artery, but clinically very Less need for aortic angiography.
Differential diagnosis
To rule out other causes of duodenal obstruction, such as inflammatory masses near the ligamentum flavum, congenital giant duodenum, annular pancreas, duodenal septum and tumor, the latter two can be used for fiber endoscopy To help diagnose, the symptoms are not typical, still need to exclude stomach, duodenal ulcer, cholelithiasis, cholecystitis, pancreatitis and duodenitis, etc., in recent years, there have been chronic duodenal obstruction with ulcer disease or pancreas Inflammation reports require attention when diagnosing.
